Healthcare Provider Details

I. General information

NPI: 1992824924
Provider Name (Legal Business Name): FORRESTON FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E. MAIN STREET
FORRESTON IL
61030-0212
US

IV. Provider business mailing address

P.O. BOX 260
MENDOTA IL
61342-0260
US

V. Phone/Fax

Practice location:
  • Phone: 815-938-2345
  • Fax:
Mailing address:
  • Phone: 815-539-2468
  • Fax: 815-539-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1369688
License Number StateIL

VIII. Authorized Official

Name: MR. JACK ROYCE DAWS
Title or Position: PRESIDENT OF BOARD
Credential:
Phone: 815-262-3531